Agenda item

Ian Ayres (Chief Officer, NHS West Kent CCG), Dr Bob Bowes (Chair, NHS West Kent CCG), Felicity Cox (Kent and Medway Area Director, NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman introduced the item and welcomed representatives of NHS West Kent CCG as the first CCG to bring their strategic plans to the Committee.

(b)       Dr Bowes presented an overview and began by explaining that the Mapping the Future programme was a long term project aimed at dealing with the funding shortfalls of £20 million each year. With an ageing population and long terms conditions on the rise, if no changes were made there would be a £62 million shortfall in the next five years. In the past, old style management consultant exercises had been carried out to identify efficiencies. These had gone nowhere as providers had not been involved. The Mapping the Future programme involved them, commissioners, and the public in the redesign, with 4 different clinical scenarios used to develop ideas. Seeking the views of HOSC was a core part of this engagement exercise. There was a diagram on page 73 of the Agenda which set out how the relationship between the sectors of the health economy could be redone.

(c)        All of this was underpinned by a tremendous data challenge and the Department of Health was working with GPs to work out the best way to use data effectively and be able to share it across organisations.

(d)       A question was posed about how Mapping the Future was being publicised and communicated. The offer was made to send the Committee a written report setting this out in more detail.

(e)       A question was posed about the structure of the health service and whether this meant organisations were more in silos than in the past. It was conceded that there were more autonomous organisations but now that 5-6 years of expanding budgets had ended, there was more of an emphasis on collaboration. CCG representatives explained that 3 key ideas had come out of Mapping the Future workshops. First, it was recognised that continuing to do the same things, but working harder and faster, would buy a little bit of time but there was rather a need to do something fundamentally different. Second, there was a recognition that all sectors were impacted and needed to respond and act. Third, there was increasing acceptance of the idea of ‘the Kent Pound.’ This phrase was used as shorthand for the recognition that there was only one finite sum of money for health and care across Kent and health and social services needed to work together, if debt was not to be just moved around the system.

(f)         A number of specific questions were asked about the financial structure of the new NHS, some of which were more generic than specifically about West Kent. On behalf of NHS England, Felicity Cox undertook to provide the Committee with a breakdown of how the funding flowed down the NHS structure. CCG representatives explained that CCG’s provided no services but were the commissioners of the majority of health services in Kent and so held contracts with the various providers. West Kent CCG received approximately £1,000 per head of population, with a fixed £25 per head for administration. This funding was lower than for other areas of Kent and it was explained that it was not a straightforward capitation funding system. There was a complex funding formula which had been in use for a number of years and this gave a heavy weighting to deprivation but less to age. As a consequence, West Kent also received a smaller amount per head of population than other areas in the days of Primary Care Trusts. The Department of Health and NHS England were looking at future models of funding. On a capitation model, West Kent CCG would receive an additional £40 million annually.

(g)       It was also explained that CCGs commissioned healthcare for all people in their geographical area and this included the responsibility for funding the healthcare of people resident in the area who fell ill and/or received treatment in different CCG areas. There was a discussion with Members about the size of CCGs with the view being expressed that West Kent CCG was too big to respond to local concerns. In response it was explained that West Kent CCG mapped the area broadly covered by Maidstone and Tunbridge Wells NHS Trust and that CCGs needed to be a certain size to be effective and that this did not mean the local dimension was lost.

(h)        There was also a discussion on the possible tension between putting patients first and balancing budgets. CCG representatives explained that fiscal responsibility was the best means to ensuring patients needs were met. If a service was not sustainable and ceased to function, this would not be in anyone’s interest. The view was expressed that the balance was too much in favour of the hospital sector historically. It was not that hospitals hung onto patients in order to make money but rather there was a need to share skills and responsibilities in order to enable patients to be transferred. Another challenge was that the tariff for services did not always match the real costs.

(i)         In response to a specific question, it was accepted that Borough/District Councils should be listed in the Mapping the Future document as stakeholders.

(j)         The value of pharmacies was raised and acknowledged. However, there was discussion of some oddities in the pharmacy system. There were a number of drugs where the cost of them was much less than the prescription charges but they were not available without a prescription and a charge being made. In response to a specific example being described, it was explained that there were occasions when paracetamol was prescribed. There was a limit to 32 of the number of paracetamol which could be purchased over the counter. Some people required a larger amount and a prescription was issued, though this would normally only be to patients who received free prescriptions anyway. If paracetamol was prescribed to someone who needed to pay, this was most likely an oversight.

(k)        In response to another specific example, it was explained that the GP contract meant the practice should be available in some form between 8.00 am and 6.30 pm, Monday to Friday, even if the surgery was physically closed. The surgery should not close at lunchtime and just provide a telephone message asking people to call 111. If this was the case, Felicity Cox as the representative of NHS England, which held GP contracts, requested the name of the practice.

(l)         On the topic of GP opening hours, the question of their being inconsistent across Kent was raised by Members. It was explained that practices had a choice between cutting costs and expanding services and this tension was not new. The view was expressed by Members that GPs could work longer hours to assist with access and reducing attendances at accident and emergency departments. Both GPs in attendance countered that they were both working longer hours than in the past and this was not practical.

(m)      The Mapping the Future programme would continue to develop and more detail as to how the ideas in it would be progressed would be forthcoming in the future. It was also explained that the Mapping the future programme involved a wide range of clinicians and these had experience of good practice both nationally and internationally.

(n)        The Chairman proposed the following recommendation:

§         That the Committee thanks its guests for their attendance and contributions today, asks that they take on board the comments made by Members during the meeting and looks forward to receiving further updates in the future.

(o)       AGREED that the Committee thanks its guests for their attendance and contributions today, asks that they take on board the comments made by Members during the meeting and looks forward to receiving further updates in the future.